Provider Demographics
NPI:1679544407
Name:MUNDT, SUSAN E (MPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MUNDT
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 W 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3131
Mailing Address - Country:US
Mailing Address - Phone:816-932-5967
Mailing Address - Fax:816-932-8661
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:2ND FLOOR PEET BUILDING
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-5967
Practice Address - Fax:816-932-8661
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOC308170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS